Why "Impairment Ratings" Don't Belong in Our FCE course
Sometimes we are asked whether or not our Functional Capacity Evaluation Certification Program includes training on how to perform an Impairment Rating Evaluation. In short, the answer is no, we do not. And there are very good reasons why:
In some states, only specialists who have been certified by the American Board of Medical Specialists (ABMS) can provide impairment ratings for workers' compensation patients, but there are other states that allow Physical Therapists and other non-certified professionals to perform them. Also, there are different systems used for measuring impairment and not all systems are universally accepted. Some states require the use of specific editions of the AMA Guides to Evaluation of Permanent Impairment, while other states use an entirely different system altogether.
Since Matheson's FCE trainings are held throughout the the US and Canada, and we have students coming from all fifty states, Canada and all over the world, we cannot dedicate the adequate amount of time it would take to teach all systems of measuring impairment as it would apply to the requirements of our students' home-state or country. Also, our FCE courses are largely attended by PTs and OTs who, in some states, are not even permitted to perform Impairment Ratings! Talk about providing completely irrelevant information to students who came to our course eager to learn about Functional Capacity Evaluation!
Instead, Matheson's area of expertise, and the focus of our FCE course, is on Return-to-Work (RTW) and Disability Ratings, and they are totally different specializations than Impairment Ratings. These in themselves (RTW and Disability) are big topics and the 5-day training delves into these topics in detail as they relate to Functional Capacity Evaluation. The goal of our FCE course is to produce Thinking Evaluators that practice at a higher level and are well-respected by their referral sources and peers for the quality of critical thinking that they put into their FCEs. We believe that going off on a tangent on Impairment Rating would dilute the quality of our FCE training.
Our resource for guiding you toward doing reliable and valid disability evaluation via Functional Capacity Evaluation is fairly straight forward: We follow recent rulings in our federal courts.
Courts around the U.S. are delving into the inability of a physician to determine work disability from an impairment rating. In recent cases, they have discussed the separation of impairment from disability, stating that an impairment rating alone cannot be used to determine work-ability. The new Americans with Disabilities Act as Amended (ADAAA) makes it clear that there is no link and the AMA Guides to the Evaluation of Permanent Impairmen, Sixth Edition also clearly delineate their thinking on this subject:
Chapter 14, page 356, paragraph 6: “Impairment scores do not, in themselves, indicate whether a patient can work or not. This is an independent assessment that must be made during the evaluation.”
Chapter 14, page 352, paragraph 2: “Reliable collateral information concerning the individual’s behavior while performing activities of daily living (ADLs) may be drawn from medical and nonmedical sources. Records from hospitalization, outpatient treatment, day hospital, rehabilitation evaluations, work evaluations and disability assessments are useful in assessing the status of the patient. Helpful nonmedical sources may include records from vocational assessment, sheltered workshops, or day care centers.”
Chapter 1, page 6, paragraph 2: “The guides is not intended to be used for direct estimates of work participation restrictions. Impairment percentages derived according to the Guides’ criteria do not directly measure work participation restrictions.”
Chapter 1, page 6, paragraph 3: “In disability evaluation, the impairment rating is one of several determinants of disablement. Impairment rating is the determinant most amenable to physician assessment; it must be further integrated with contextual information typically provided by nonphysician sources regarding psychological, social, vocational, and avocational issues.”
Not sure whether you are looking for a course focused on disability evaluation or impairment rating evaluation? Not even sure what the difference is?
First, separate impairment from disability. Typically it is very difficult for a physician in particular to do this, but it is crucial in the long run if you want your practice to be respected in either area of expertise because they are not the same!
Impairment is permanent damage to one or more systems of the body from disease or injury. The AMA Guides to the Evaluation of Permanent Impairment (Fifth Edition), defines impairment as "an alteration of an individual's health status; a deviation from normal in a body part or organ system and its functioning."
Disability is the functional or vocational consequence of the impairment, defined by the AMA Guides (Fifth Edition) as "an alteration of an individual's capacity to meet personal, social, or occupational demands because of an impairment."
Disability can exist in the absence of impairment (think willingness to work, for example). Disability may also not exist in the presence of impairment (think top-level athlete).
If you are interested in learning more about impairment rating, check with your governing board (PT, OT, etc.) for your state and find out which system they require (or suggest) for Evaluation of Permanent Impairment. If it is the AMA Guides, as mentioned above, be sure that you are looking at the most recent edition. The information on impairment that you are likely to be doing is usually found in the Musculoskeletal or Range of Motion section. (There are other systems of the body on which an Impairment Rating can be done, but you will likely not focus on those.) Usually all it involves is assessing their ROM or function, filling out a form and giving it to a doctor.
Essentially, there is really no reason to take an entire course on it. And it certainly doesn't belong in an FCE course.
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